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ADVICE ABOUT YOUR FOOTWEAR
Kidney disease is a lifelong condition which may cause foot problems. Some of these problems can occur because the nerves and blood vessels are damaged.

This can affect:
- the circulation in your feet (ischaemia);and
- the feeling in your feet (peripheral neuropathy).

These changes can be very gradual and you may not notice them. This is why it is important that every year you have your feet screened by a suitably-trained professional or assessed by a podiatrist. You can then agree on a treatment plan to suit your needs.

This leaflet gives you advice about wearing the most appropriate shoes, taking into account the shape of your feet and your renal condition.

Prescription footwear and insoles can reduce the risk of ulcers but cannot remove the risk altogether.

Unsuitable shoes or shoes that don’t fit properly are a common cause of foot problems in people with kidney disease.

Controlling your cholesterol and blood pressure, quitting smoking, increasing cardiovascular exercise, controlling weight and managing any other conditions you may have (such as diabetes) helps to reduce the risk of these life- and limb-threatening problems. Managing any excess fluid is also important.

Note : You may also be at further risk of cardiovascular problems if you have a family history of heart disease.

As your feet are at high risk of foot ulcers, you will need to take extra care of them. You will need regular foot assessments and may require treatment by a podiatrist.

At the start of each dialysis cycle you should be asked to remove your footwear and socks or stockings so that your feet can be examined. A trained health-care professional will look for any signs of corns, calluses, changes in foot shape and changes in colour or temperature. Healthcare professionals should also check your feet for numbness or changes in sensation (nephropathy).

Footwear advice

Check your feet every day
Check your feet every time you remove your shoes. Also remember to remove your socks, stockings or tights and check for any redness or blisters.
Check your shoes every day
Check the bottom of your shoes before putting them on to make sure that nothing sharp such as a pin, nail or glass has pierced the outer sole. Also, run your hand inside each shoe to check that no small objects such as small stones have fallen in.

The shape of your feet

Your feet can change shape over time. So, when you buy new shoes, always check their fit carefully.
Buying new shoes

Get your feet measured
If possible have your feet measured and your new shoes fitted properly.

Well-fitting shoes 
Make sure your shoes are long enough, deep enough, and wide enough for your feet. If your shoes are too tight they will press on your toes. 

Always try on both shoes
When buying new shoes, always try on both shoes. Most people’s feet are slightly different sizes.

Buy your own shoes
If possible you should go to the shoe shop yourself and not ask somebody else to buy your shoes for you.

Wear new shoes around the house
Wear new shoes around the house for short periods (20 minutes) and then check your feet. Look for problems such as redness caused by rubbing or pressure. If this happens, you can usually return the shoes to the shop, but only if you have not worn them outside.

Advice on new shoes
If you are not sure if your new shoes are suitable, ask your podiatrist for advice before you wear them.

Recommended footwear

Types of shoes
A well-fitting shoe, boot or trainer with laces or a strap fastening will give your feet the best support. These fastenings will help to keep your foot firmly in place inside your footwear which will help prevent rubbing.

Avoid slip-on shoes and slippers as they give less support. Stop wearing slippers once you have been given prescribed footwear and insoles.

Heel height
The heel of your footwear should not be more than 3 centimetres (1¼ inches).

Natural materials

Where possible the uppers (top) of your shoes should be made from a natural material such as soft leather. Leather will fit to your foot without causing any rubbing and will help to prevent your feet from sweating.
Check the condition of your prescribed footwear and have repairs done when necessary.

Wear and tear

Signs of wear and tear

Check your shoes for signs of wear, such as rough edges in seams or linings, and worn soles or heels. Always check your shoes are in good condition and replace them whenever there are signs of wear and tear that can’t be repaired.

Prescription shoes

If you have been supplied with shoes, they will have been made to a prescription. You should follow the instructions of your orthotist or podiatrist with specialist training in prescribing footwear (the person who designed or prescribed your shoes) gives you. At first you should wear the shoes for short periods around your home, checking for any problems such as redness caused by rubbing or pressure. If this occurs, you should contact your podiatrist or orthotist immediately.

When you and the person who prescribed your shoes are happy with the comfort and fit of the first pair, you will be supplied with a second pair.

These should be the only shoes you wear.

It is important that you wear these shoes inside and outside the house.

Shoes will normally be prescribed with insoles.

These are an important part of your footwear and you should only remove them if your podiatrist or orthotist advises you to. It is important that you check the inside of your shoes every day to make sure no small objects have fallen in, and that there is no damage to the insole or lining.

If you notice any wear or damage to the shoes, you should contact your orthotist or podiatrist so that they can be repaired.

Whoever provided your shoes will advise you about any repairs or alterations to make sure that they still match your prescription.

Socks, stockings and tights
You should always change your socks, stockings or tights every day. They should not have bulky seams and they should not have elasticated tops. Some high-street shops sell suitable products - ask your podiatrist for details. All your socks, stockings and tights should be the right size for your feet.

Remember: if you are not sure about any shoes, socks, stockings or tights you are wearing, or new shoes you have bought, your podiatrist will be happy to advise you.

If you discover any more problems, or if you are concerned about the treatment of your foot ulcer, contact your Multi-Disciplinary Foot Care Service, local Podiatry Department or GP for advice immediately.

Developed by the London Foot Care Strategic Clinical Network and the London Renal Strategic Clinical Network

More foot care information at the links below

Charcot Feet

Foot Ulcers

Holiday feet

The National Kidney Federation cannot accept any responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.